Adjunct medications for peripheral and neuraxial anesthesia

Emelife, Patrick I.; Eng, Matthew R.; Menard, Bethany L.; Myers, Andrew S.; Cornett, Elyse M.; Urman, Richard D.; Kaye, Alan D.

doi:10.1016/j.bpa.2018.06.011

Cited by 50 publications

(43 citation statements)

References 51 publications

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“…Commonly used adjuncts are opiates, including morphine, buprenorphine, diamorphine, hydromorphone, tramadol and fentanyl, the former causing greater respiratory depression. Less common adjuncts include clonidine which, when used in neuraxial blocks, blocks the sympathetic outflow. Compared with IVPCA opioids, pain is modestly improved with EA following intra‐abdominal surgery, with a statistically, but non‐clinically, significant reduction in pain scores at rest.…”

Section: Pharmacological Management Of Postoperative Painmentioning

confidence: 99%

“…The majority of research evaluating adjuncts originates from limb blocks, and details are beyond the scope of this article. However, in general, morphine and fentanyl do not improve the quality of analgesia but increase side‐effects, whereas dexamethasone, clonidine and ketamine can prolong the duration of analgesia but are all associated with unwanted side‐effects owing to systemic absorption.…”

Section: Pharmacological Management Of Postoperative Painmentioning

confidence: 99%

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Acute postoperative pain management

Small

Laycock

2020

British Journal of Surgery

204

100

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Background Acute postoperative pain is common. Nearly 20 per cent of patients experience severe pain in the first 24 h after surgery, a figure that has remained largely unchanged in the past 30 years. This review aims to present key considerations for postoperative pain management. Methods A narrative review of postoperative pain strategies was undertaken. Searches of the Cochrane Library, PubMed and Google Scholar databases were performed using the terms postoperative care, psychological factor, pain management, acute pain service, analgesia, acute pain and pain assessment. Results Information on service provision, preoperative planning, pain assessment, and pharmacological and non‐pharmacological strategies relevant to acute postoperative pain management in adults is presented, with a focus on enhanced recovery after surgery pathways. Conclusion Adequate perioperative pain management is integral to patient care and outcomes. Each of the biological, psychological and social dimensions of the pain experience should be considered and understood in order to provide optimum pain management in the postoperative setting.

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Section: Pharmacological Management Of Postoperative Painmentioning

confidence: 99%

Section: Pharmacological Management Of Postoperative Painmentioning

confidence: 99%

Acute postoperative pain management

Small

Laycock

2020

British Journal of Surgery

204

100

View full text Add to dashboard Cite

show abstract

“…The simultaneous use of several drugs (with pharmacological synergism) allows the anesthesiologist to decrease the total dose employed, when compared to the isolated use of each of them. This is one of the reasons for the use of adjuvants with the LA [24][25][26]. Another reason is to reduce opioid consumption in the post-operative period and associated collateral effects.…”

Section: Non-anesthetic Drugs (Adjuvants) Injected Together With La (mentioning

confidence: 99%

Local Anesthetics Infiltration and Wound Healing Process

Abrão¹,

Antunes²,

Garcia³

2020

Topics in Local Anesthetics

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It is a good practice, nowadays, to infiltrate local anesthetics along the incision to prevent postoperative pain. This can reduce the use of opioids and the side effects they cause. It is known clearly that the surgical trauma causes inflammatory reaction, and this can be the beginning of a bad cicatrization or even a scar. The use of local anesthetics preventing the acute pain is a very simple technique and has proved to be useful. Nevertheless, the reaction that various anesthetics have over the tissues and the cicatrization process is yet controversial and deserves to be investigated deeply. The use of different formulations of these drugs has been stimulated. The duration and secureness have been the goals of many researches. Levobupivacaine, ropivacaine, and bupivacaine for their long action; lidocaine for less toxicity; and liposomal formulation for the longest duration ever seen, all of them have been indicated in the postoperative pain management. The aim of this chapter is to evaluate the role of long duration local anesthetics on the inflammatory reaction and consequently the collagen production and resistance of the tissue to traction.

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“…Therefore, appropriate adjuvants are added to local anesthetics during spinal anesthesia to enhance the blockage quality and extend the block duration. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

Wang

Song

et al. 2020

J Int Med Res

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Objective To compare the efficacy of dexmedetomidine and magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia. Methods A search of PubMed, Medline, Embase, the Cochrane Library, and Google Scholar was performed. Randomized controlled trials comparing the efficacy of dexmedetomidine and magnesium sulfate as a local anesthetic adjuvant in spinal anesthesia were identified. The primary outcome was sensory block duration. The mean difference (MD) or odds ratio along with the 95% confidence interval (CI) was used to analyze the outcomes. Results Six studies involving 360 patients were included. Intrathecal dexmedetomidine was associated with a significantly longer sensory block duration (MD = −73.62; 95% CI = −101.09 to −46.15), faster onsets of sensory blockade and motor blockade, and a longer motor block duration than intrathecal magnesium sulfate. There was no significant difference between the regarding the rates of hypotension, bradycardia, shivering, and postoperative nausea and vomiting between the groups. Conclusions Dexmedetomidine is superior to magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia because of its more rapid onset and longer duration of spinal block without significant adverse effects.

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Adjunct medications for peripheral and neuraxial anesthesia

Cited by 50 publications

References 51 publications

Acute postoperative pain management

Acute postoperative pain management

Local Anesthetics Infiltration and Wound Healing Process

Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

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